Continuing Care Retirement Community

A Primer

continuing care retirement community
A CCRC allows healthy older adults to live in a community setting, assured that all of their medical needs will be met over their lifetime, allowing them peace of mind and time to enjoy the nicer things in life.. Getty Images

A Continuing Care Retirement Community (CCRC) is a type of community that typically has independent living, assisted living and skilled nursing all on one campus. Residents move as needed from one level of care to the next in a seamless continuum of services.

The Commission on Accreditation of Rehabilitation Facilities (CARF) is the nation's only accrediting body for continuing care retirement communities.

It is important to find out if the community you are researching is certified.

Social programs, meals, activities, fitness facilities, pool, library, computer center, housekeeping and laundry services are usually provided.

Who Pays?

With the exception of Medicare or Medicaid reimbursed services, typically in the skilled nursing and skilled home health areas, the resident enters into a contract with the CCRC and pays out of pocket.

A Lifecare Retirement Community is a type of CCRC where residents typically pay a little more but are guaranteed lifetime care even if their finances run out.

To many, if they can afford it, a CCRC is the best of all worlds offering independence and privacy of living, opportunities for socialization, active lifestyles with the security of health services nearby.

Choosing to live in a CCRC is costly. A large entrance fee is usually required. This can be as little as $10,000 and as much as $500,000.

Residents also pay a monthly maintenance fee, which can range from roughly $200 to more than $2,000.

What is an Assisted Living Facility?

Assisted living is a senior living option that combines housing, support services, and health care, as needed. Assisted living is designed for individuals who require assistance with what are called activities of daily living (ADL).

These include:

  • Personal hygiene and grooming
  • Dressing and undressing
  • Feeding
  • Functional transfers
  • Voluntarily controlling urinary and fecal discharge
  • Elimination
  • Walking/Ambulation

Who Pays?

The resident pays typically on a month-to-month lease. The basic rate may cover all services or there may be additional charges for special services. Some states offer "home and community-based waivers" that allow low-income residents to live in assisted living with Medicaid assistance. Long-term care insurance will also pay.

Assisted living communities provide many of the services as the CCRC. Many are built in proximity to hospitals. They may offer emergency call systems, medication management and other health and safety options.

Research indicates that organizations with 300+ units appear to be leading the way in CCRCs. There is interest in growing partnerships, in particular with active adult communities, other CCRCs, colleges/universities, for-profit ventures, NORCs, other senior living, providers, and state/local government agencies.

Consumer choice will continue to be a central focus in planning future facilities and services.

What is a Skilled Nursing Facility?

A Skilled Nursing Facility (SNF) is a nursing home certified to participate in, and be reimbursed by Medicare and/or Medicaid.

States license nursing homes, making them subject to the State's laws and regulations. And they are also subject to federal laws and regulations because of their participation in Medicare and/or Medicaid.

Patients and residents in skilled care are there for a reason.

Their medical and mental condition requires it. While nursing homes used to be thought of as one-way trips, more and more they are being used for the rehabilitation of hospital patients, for example, knee and hip replacement patients.

Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants (CNA). Federal requirements mandate that a Registered Nurse (RN) be on site sight eight consecutive hours, seven days a week. A Licensed Nurse (LN) is required for the two remaining shifts, seven days a week. A full time director of nursing and a licensed nursing home administrator are other positions found in SNFs.

Who Pays?

  • Medicare covers nursing home services for 20 to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. A physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis.
  • Rehabilitation services for younger patients/residents, for example boomers not eligible for Medicare, may be paid by private insurance if they have it.
  • Once Medicare eligibility expires or if a person enters a facility without a prior hospitalization, the following scenario is typical.

    The resident pays out of pocket.

    The resident without long-term care insurance qualifies for Medicaid, which then pays for care.

    The resident has long-term care insurance that covers some or all of costs.

    This is very much a simplified version as financing skilled care can be a maze that takes skill to navigate.

    State surveyors inspect nursing homes for compliance with licensure (State regulations) and/or certification (Medicare and Medicaid regulations). Inspections vary widely by state depending on resources and individual state requirements.

    The "Mininimum Data Set" assessment (MDS), now MDS 3.0, is a federally mandated process for comprehensive assessment of all residents in Medicare or Medicaid certified nursing homes. The MDS assessment is a screening assessment that forms the basis of a comprehensive assessment of each resident's functional capabilities and helps nursing home staff build a plan of care for residents. The MDS also yields "Resource Utilization Groups" (RUGS) which are used for all Medicare reimbursement to SNFs, and is used in many States as well.

    The Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics.

    It is called Nursing Home Compare. They also publish a list of Special Focus Facilities - nursing homes with a history of serious quality issues.

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